SSRI toxicity

Background

Most serious adverse effect is potential to produce Serotonin Syndrome
Fatalities are uncommon with pure overdoses

Clinical Features

Nausea and vomiting
Sedation
Tremor
Sinus tachycardia
QRS, QT prolongation (citalopram only)
Serotonin syndrome
Coma and seizures (rare)

Differential Diagnosis

Serotonin syndrome

Anticholinergic toxicity Causes

Medications
- Atropine
  - Lomotil toxicity
- Antihistamines
- Antidepressants
  - Tricyclic antidepressant (TCA) toxicity
  - SSRIs
- Antipsychotics
- Muscle relaxants
- Anti-Parkinsonians
Plants
- Jimson weed (Devil's trumpet)
- Amanita mushroom

Management

Supportive care
No role for activated charcoal or gastric lavage
Magnesium sulfate 2g IV if QTc > 500 msec
IV benzodiazepines if agitation or seizures

Disposition

Consider admission for patients who are tachycardic or lethargic 6hr after ingestion
ECG before clearing a patient with citalopram ingestion

See Also

References

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